Nurse understaffing associated with adverse outcomes for surgical admissions

Abstract

Background: nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes.

Methods: a longitudinal patient analysis was conducted in four organisations in England using routine data from 213,910 admissions to all surgical specialties. Patients’ staffing exposures were modelled as counts of understaffed registered nurse (RN) and nurse assistant (NA) days in their first five inpatient days. Understaffing was identified when staffing per patient day was below the mean for the ward. Cox models examined mortality within 30 days of admission and readmission within 30 days of discharge. Generalised linear models examined length of stay and occurrence of hospital-acquired conditions.

Results: increased exposure to RN understaffing was associated with longer length of stay and increased risk of deep-vein thrombosis, pneumonia and pressure ulcers. This was also true for NA understaffing but the effect sizes tended to be smaller. In the Cox models, there were similarly increased hazards of death for RN understaffing (HR 1.092, 95% CI 1.066,1.118) and NA understaffing (HR 1.103, 95% CI 1.077, 1.129), whereas the effect size of RN understaffing for readmission (HR 1.023, 95% CI 1.019, 1.028) was greater than that seen with NAs (HR 1.014, 95% CI 1.010, 1.019).

Conclusion: understaffing by both RNs and NAs is associated with increased risks of a range of adverse events and generally larger effects are seen with RN understaffing.

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Identifiers

ORCID for Paul Meredith: orcid.org/0000-0002-5464-371X

ORCID for Lesley Turner: orcid.org/0000-0003-1489-3471

ORCID for Christina Saville: orcid.org/0000-0001-7718-5689

ORCID for Peter Griffiths: orcid.org/0000-0003-2439-2857

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